
^ # 

I UNITED STATES OP AMERICA. | 



REVIEW 

OF 



An Essay on the Bilious Epidemic Fever ^ 

PREVAILING IN THE 

STATE OF NEW- YORK: 

BY 

CHRISTOPHER C, YATES.'^ 

ADDITIONAL REMARKS, 

BY 

A PHYSICIAN. 



ALBANY: 

1*RINTED by E. and E. HOSFORD5 FOR THE AUTHOR, 

1813. 



■I 



INTRODUCTION. 



When a writer treats of a disease which is epidem- 
ic, uncommon and alarming, the interests of commu- 
nity require a faithful detail of facts, and a judicious 
selection of remedies. Professional jealousies so 
common to the Faculty, should ever yield to the vi- 
tal importance of the subject. A mind obscured 
with prejudice is extremely ill qualified to investi- 
gate truth and to detect error. The primary object 
is always lost in a solicitude to detract from indi- 
vidual reputation, and the author is consequently 
involved in absurdities and contradictions. 

These remarks were occasioned by the perusal of 
a pamphlet entitled " An Essay on the Bilious Ep- 
idemic Fever, by Christopher C. Yates." 

The course which he has adopted, imposes on 
me the humiliating necessity of descending to a refu- 
tation of the numerous errors which he has attempt- 
ed to propagate. 

I feel myself constrained to beg pardon of the 
friends of science, for the remarks which I may be- 
stow upon this publication, and also for that infringe- 
ment of decoruai which the occasion imperiously de- 
mands. A course stirctly decorous would render 
this a very inefficient and inapposite review of the 
Pamphlet before us. 

From a peculiar aversion to this species of contro- 
versy, and a decided conviction that the erroneous 



it 



INTRODUCTION. 



Tiew which Dr. Yates had taken of the subject, was 
too obvious to escape notice or to require exposure, 
and also from a hope that some abler pen would 
have been wielded in defence of truth, I had for a 
long time resolved to be silent; but when I discover- 
ed the editor of the Albany Register and hk erudite 
correspondents lavishing high encomiums upon this 
publication; when I saw the same commendations 
reiterated in the Utica Patriot, and ascribed to Dr, 
Alexander Coventry, of that village, and the effect 
which was thus produced in the minds of some Med- 
ical gentlemen in favour of the pamphlet, I hesita- 
ted whether to suspect a universal delusion, or to 
doubt the evidence of my own senses : I however, 
charitably adopted the opinion that the gross errors 
every where conspicuous, were concealed in the im- 
portance and novelty of the subject ; and that a soli- 
citude to acquire information of the Epidemic, pre- 
cluded the discovery of palpable contradictions. Had 
these however been of minor importance and not es- 
"Sentially influenced the treatment of a disease, which 
in injudicious hands was marching with rapid strides 
to a fatal issue, I should have persevered in my de- 
termination. 

But when I witness in this pamphlet the boasts of 
extraordinary success, the positive prohibition of ev- 
ery remedy except emetics and cathartics, the revi- 
val of a proximate cause of fever, wh :ch has been 
long since exploded from the annals of Medicine as 
absurd and ridiculous. When I hear of the uncom- 
mon mortality of the Epidemic where this treatment 
hn^ been rigidly pursuedj and the lingering debility 



INTRODUCTION, 



V 



of those who finally convalesce, I am impelled by 
every sense of duty and humanity, no longer to with- 
hold my disapprobation of such opinions and such 
practice. 

Should I fail in producing full conviction in the 
public mind, of the truth of the allegations I have 
made, I trust I shall not wish to avert those just de- 
nunciations of their displeasure which I may thence 
incur. 

I extremely regret the necessity of exposing the 
errors of the author at the expence of his veracity, 
but the public good requires that such an exposure 
should be made, however it may affect the moral 
or medical reputation of any individual, and if, in 
his zeal to acquire celebrity, he has been regardless 
of the effects which these may produce upon com- 
munity, the rod of correction cannot he too freely ap- 
plied. 

I cannot omit this opportunity of expressing my 
decided disapprobation of those Medical Journal- 
ists, who review publications of this nature without 
exposing their prominent defects. This unmerited 
indulgence gives currency to error, and stamps im- 
perfection with a degree of importance to which it 
never can be entitled. 

While the opinions of reviewers are considered 
decisive of the merits or demerits of a work, they 
certainly should be expressed with critical accuracy, 
and the most rigid impartiality ; by pursuing this 
course, the review will obtain a reputation which it 
never can acquire from an indiscriminate profusion 
of applause. 



INTRODUCTION, 



In reviewing Doct. Yates' pamphlet I shall ad- 
here to the order which he has pursued and select S 
few prominent passages for critical remarks. Gram- 
matical errors are of minor importance and too nu- 
merous to be noticed. They must occur to the ob- 
servation of every correct reader in almost every 
page of his publication. As I am collecting materi- 
als, from authentic sources, not founded on ''vague 
rumour," for a correct history and treatment of the 
Epidemic, I shall therefore render this review as 
brief as possible. It is merely a temporary caveat 
to the public to prevent the general diffusion of 
error. Enough is said to produce conviction of 
its inaccuracy, while much is reserved for the reader 
to examine. When the subject is resumed, the base 
on which Doctor C. €. Yates has erected his vn- 
mense fabric will be so perfectly demolished by au- 
thentic documents, that ''not one stone shall be left 
upon another/' 



REVIEW, 4:c. 



Dr. YATES says, "In the summer and fall of 
1812, a considerable number of deaths occurred in 
the encampment at Greenbush, of this prevailing Ep- 
idemic/' That about the first of May, 1813, 
the disorder continued to prevail in Albany with un- 
diminished malignity, and that in other counties and 
states where it had not before appeared, it commen- 
ced with the opening of spring- 
It m.ay be remarked that the Dr. has advanced an 
opinion that this Epidemic isnota winter disease, but 
that it is equally prevalent at all seasons of the year, 
1 will not positively assert that he designedly mistates 
facts for the purpose of supporting this opinion, but 
I can freely declare that I have never heard of the 
Epidemic prevailing in the vicinity of Albany du- 
ring any of the summer months. I have heard a ve- 
ry respectable and intelligent surgeon of the army 
say, that the disease which first appeared among the 
soldiers in the fall of 1812, was highly inflammato- 
ry, resembling a peripneumonia notha, that the blood 
when drawn was always indicative of that inflamma- 
tion, and that no permanent relief could be obtained 
without recourse to this remedy — but that after the 
commencement of the extreme cold of winter, the 
type and symptoms were totally changed, Solici- 



8 



tious to establish the position he has taken, the Dro 
might easily mistake this for his favourite Epidemic. 
Such errors are unpardonable in an author who at- 
tempts to found thereon important principles in med- 
icine. 

The only apology that I can offer for this precip- 
itate declaration is, that his mind is more prone to 
adopt contradictory opinions upon any evidence, 
than to investigate truth upon its true basis. Had 
he affirmed this fact by the testimony of occular de- 
monstration or the citation of competent authority, 
it would have been entitled to credence ; but when 
it rests upon no better ground than vague rumour, the 
Dr. will excuse my incredulity. With respect to his 
assertion that the Epidemic continued to prevail in 
Albany on the first of May, 1813, with undiminished 
malignity, I have no hesitation to deny the position, 
and shall even presume to adduce the Dr. himself 
in evidence. I do confidently affirm that at this 
time but few cases remained, and that by the middle 
of June not one well marked new case was to be 
found, unless the Doct. pleases to denominate every 
''ache and indisposition a case of the Epidemic." 
That he perfectly coincides with me in this opinion, 
may be fairly inferred from his taking advantage of 
this healthy season to make a pleasurable excursion 
to New- York — would the Dr. be so inhuman as to 
disregard the " agonizing cries of his patients' for re- 
lief," and abandon his duty at this critical juncture 
for a pleasant sail in the steam-boat ? The Doctor's 
heart has certainlv been insensible to the calls of hu- 
manity, or he has been guilty of a gross mistatement 



9 



of facts. This inference acquires additional strength 
from the consideration that two other physicians of 
extensive practice were absent from Albany on a vi- 
sit to New-York at the very same time, when Dr, 
Yates says the Epidemic prevailed with undiminish- 
ed malignity. Not so in the winter. Not a physi- 
cian dared then to desert his post ; in confirmation of 
this I will state one fact. A Mr. Nehemiah Pratt on 
the western turnpike, three miles from Albany, was 
seized with the Epidemic in January ; with much in- 
treaty he was able to procure but three or four visits 
from different Physicians in Albany ; his messengers 
repeatedly afterwards requested and urged every 
practitioner they could find to visit Mr. Pratt, but 
in vain. The sick man was suffered to languish four 
days without any medical aid, w hen he died. No 
party of pleasure, no calls of humanity could then 
entice any practitioner from Albany ; not even Dr. 
Yates himself. At any other time twenty Physicians 
would have vied with each other to obtain this 
patient. But no sooner does warm weather com- 
mence and with it " an increased malignity of the dis- 
ease,'' than the Physicians leave the city almost des- 
titute of medical aid. 

The correctness of these deductions I trust the Dr. 
himself will not controvert. 

It is a remarkable fact which clearly design- 
ates the character of this fever, that it appeared 
last winter, earliest in those climates which are 
distinguished for the greatest severity of cold. — 
Hence in Vermont, and in the northern parts 
of this state, it occurred at the commencement of 

B 



10 



winter. In Albany about the first of January ; 
in the southern parts of this state and Connecticut, 
the last of February and first of March, and in Phil- 
adelphia not till the first of April ; south of this 1 
have not received any correct information. This 
fact unequivocally proves that whatever the cause 
may be, it requires a certain degree of cold to ena- 
ble it to pi'oduce its deleterous effects upon the sys- 
tem ; and that where the cold is severe, activity is 
immediately communicated to the a^jent, or the body 
is rendered more susceptible of its operation. But 
where the cold is less severe a longer time is requi« 
site for the same cause to produce its effects. 

But we will proceed, in tlie confident hope that 
other parts of this pamphlet will be better supported. 

" The Physicians of the army treated it as a high- 
ly inflammatory complaint, while those from the 
city who were occasionally called in to assist, treated 
it as a disease putting on the character of typhus fe- 
ver ; by the first the lancet was used with a liberal 
hand ; by the latter, brandy and laudanum were ex- 
hibited from the first attack with freedom and with- 
out measure !" 

The Dr. here designates a complete discriminating 
line between the Physicians of the city and army, 
and arranges the former nolens, volens, in * battle ar- 
ray against the latter. To say the least of this it is 
extremely uncharitable and reflects no great honour 
upon the Doctor's discernment. It is an evidence 
of his disposition to adopt general sweeping clauses 
without embarrassing himself with individual opin- 
ion. 

How extensively a difference in opinion prevailed 



11 



among the surg;eons of the army, I am not prepared 
to decide ; but this I can with confidence assert, I 
have conferred with a very respectable Physician 
of the army, and we perfectly concurred in the 
symptoms and cure of this disease, and according 
to the Doctor's own account, his opinion at this pe- 
riod was still fluctuating between bleeding and stim- 
ulants. 

I now beg leave to assure the Dr. that ever since the 
appearance of the Epidemic in our city, I have never 
entertained but one opinion upon this subject. My 
mind has never been subjected to that variety of 
changes which he ascribes to his own, and which, I 
think, from its present tone, will have to experience 
greater vicissitudes, before it arrives at the stationary 
point of truth. 

W henever I have been called to consult with those 
Physicians who were the advocates of the stimula* 
ting treatment, I have uniformly opposed their libe- 
ral use of stimulants; and certain I am that other 
practitioners in the city concurred with me in this 
opinion. I have therefore the strongest assurance 
to believe that those physicians who used exclusive- 
ly the stimulating treatment, were very limited in 
number, though "extensive in practice." The con- 
fidence with which they enjoined the use of brandy 
had an imposing influence upon popular opinion; 
and the well known case which appeared in the fall, 
in a respectable family in Lion-street, and succeeded 
under the operation of the most powerful stimu- 
lants, conduced much to sanction this practice. 

Dr, Yateg informs us that one of the physicians^ 



12 



who attended this case, afterwards abandoned his 
stimulating practice, and added " if he had not done 
so he would have lost his patients." He further in- 
forms that this physician had as yet lost no patients. 
It may be gratifying to know how near these pa- 
tients approached death before the Dr. discovered 
his error, and how manv recovered under the use 
of stimulants, and how our author will reconcile 
the success of that practice with his theory. These 
Gordian knots he will solve in the same manner and 
with the same facility as did Alexander the great. 

But his remark relative to typhus fever is equal- 
y exceptionable and an additional evidence of his 
aversion to particulars. Does the Dr. administer 
brandy and laudanum with freedom and without 
measure whenever a disease " puts on the character 
of typhus fever?" Does he pay no regard to the 
diversity of symptoms which it assumes ? Or is his 
treatment of the typhus equally simplified with his 
treatment of the epidemic ? If so, brandy will pro- 
bably constitute that " unity of remedy" which re- 
quired the boldest efibrt of his genius to discover, 
and which will perpetuate his memory to everlast- 
ing fame. 

" They felt as if they had to contend with a new 
and unseasonable enemy." 

Is the bilious fever " a nev/ enemy" ? The Dr. 
has for a moment forgotten the levity with which 
he treats the symptoms " of this misnamed terrible 
fever," in other places. 

To prevent the epidemic, " brandy was cried up as 
a sovereign remedy." 



13 



The Dr. will please to explain how he will apply 
a " remedy" before the existence of the disease it 
is intended to cure. 

" In this state of things I found much to la- 
ment and much to rejoice at. While some phy- 
sicians were so unfortunate as to lose many with 
the fever, I felt grateful that I had as yet lost 
none ; I felt happy that I stood not alone in this sit- 
uation; two other physicians of extensive practice 
had been equally fortunate, their mode of treating 
the disease was generally the same with the one 
which I had adopted, and until the 26th of January 
had lost but one patient each." 

This renjinds me of a pamphlet which Dr. Moses 
Willard wrote a few years since, to prove the success 
of his practice in a fever which then prevailed in Al- 
bany. " Of seventy-six patients which he attended," 
the Dr. states, "that he lost none, while other physi- 
cians were so unfortunate as to lose many." . 

Dr. Willard will pardon the comparison. 

But I trust our author will give as much credit to 
the success of other practitioners in Albany as he 
does to those whose names he has cited. I will men- 
tion only two. Dr. Montgomery and Dr. Sherman, 
both of whom have declared in the public papers, 
that they have not lost a single patient during the 
Avhole time the epidemic prevailed in Albany, 
From the public manner in which this declaration 
w^as made, our author must certainly have known of 
these two instances of extraordinary success, and as 
the evidence on which they rely is precisely the same 
wdiich Dr. Yates adduces in his own support, he can- 
not therefore refuse to them his most implicit confi-^ 



14 



dence. Notwithstanding all this, the Doctor s par- 
tiality has totally excluded them from a participa- 
tion of that honor which he so lavishly accumulates 
upon his two friends. 

A treatment which insured a success even superior 
to the Doctor's himself, certainly merits a distinguish- 
ed place in the third edition of his Book, and will un- 
questionably afford a valuable addition to his repos- 
itory of facts. 

At a time when the stimulating treatment was in 
its highest repute, I have heard one of its most zeal- 
ous advocates affirm in vindication of that practice, 
that without the liberal use of stimulants no patient 
ever could recover, that he had invariably pursued 
that practice and " had not then lost a single patient." 
Dr. Yates, therefore, has more company in the suc- 
cessful treatment of the epidemic, than he is willing 
to admit. But none, it appears, can ever expect to 
participate in his honors who do not implicitly adopt 
Jhis practice and his opinions. 

During the prevalence of tbc/epidemic it had be- 
come so common for practitioners to boast of their 
success, that I have frequently heard it reported of 
some who were notoriouslv the most unfortunate, 

that they had not lost a single patient." 

Disgusted with the daily repetition of such un- 
founded rumours, I adopted an opinion which I 
found to be generally correct that those who were 
raost vociferous of their own success, were such as 
had lost the most patients, or had none to lose. 

The report of those physicians who were examin- 
ed before a committee of the legislature, relative to 
Ihe state of the epidemic^ is a curious evidence of 



li> 

this fact. By this report the proportion of deaths i<y 
the number of cases was one to forty ; but no soon- 
er did the Board of Health require the name of each 
individual under their care, than this proportion was 
astonishingly changed. I heard one physician de- 
clare, that at this period his number of new cases 
had very suddenly declined. 

" When I sent him on the 26th of Jamiary the fol- 
lowing communication.'* 

The Doctor's knowledge of philology will enable 
him to explain the meaning of this short sentence — 
I am unable to decide when his communication was sent. 

" His eyes appeared to indicate an increased and 
inflammatory action in the system, which was con- 
tradicted by the pulse; this inflammatory appear- 
ance induced me to bleed him.'* 

It is astonishing that the Doctor should have had 
recourse to such a powerful remedy as bleeding, up- 
on an indication so delusive as an inflammatory eye, 
especially when that indication was contradicted by 
that true unerring test of all inflammation, the pulse. 
Has not this experience exhibited to his view a thou- 
sand instances of such deceptive symptoms in the 
last stages of a typhus gravior ? Does he not kno\^r 
that this turgid appearance of the blood vessels of 
the eyes does not originate from increased excite- 
ment, but merely from debility, and that it is a com- 
mon indication of approaching death ? If he does 
not he has another " important lesson to learn in 
liiedicine." 

The following is the Doctor s history of the treat* 
ment of this patient. — " I took eight or ten ounces 
of blood, gave him jalap and calomel, applied a 



16 



blister plaister, prescribed nitre, calomel and tartrite 
of antimony, gave him sweating draughts, wine, 
camphor, laudanum and bark , under this treatment 
the frequency of his pulse increased, he grew delir- 
ious and died on the seventh day." 

And is it possible Dr. that " under this treatment, 
your patient grew delirious and died?" Because 
bleeding and stimulants were unsuccessful in this 
case, he very deliberately condemns both. 

" My patients told me the chills were different 
from any they ever felt before. — The pulse was pe^ 
culiar and new to me." 

Notwithstanding all this he contends, it is nothing 
but a common " bilious fever." 

" The pulse exhibited every mark that would de- 
ter a prudent physician from bleeding." Yet the 
Doctor bled. 

" Full inspirations were not prevented by acute pain 
but a deadly suffocating pressureon the air vessels." 

I know not from what sources the Dr. derived his 
information, but certain I am that I have never 
known more severe, acute pains about the thorax, 
in any disease, not even in pneumonia, than I have 
v/itnessed in some cases of the epidemic. 

Every case of this misnamed terrible fever, which 
has come under my observation has yielded to this 
treatment." When the Dr. recollects the unprece- 
dented mortality that occured in a certain house in 
-tate-street, he may be induced to expunge the whole 
of this sentence from his immortal work. 

All we know is that the morbid matter is crea- 
ijng from time to time." 

The Dr. will please to inform us what " the mor- 



17 



bid matter is creating;." In his flights of imagination 
he often leads us into his " wide field of conjec- 
ture/' where we are left to roam witliout a guide. 

The Doctor's theory of the " deleterious particles 
' entering the blood-vessels and destroying the vital 
principle, thence producing the dark, purple colour 
of the face, depression of spirits, prostration of 
strength," &c- &c, &c. is as ridiculous as it is errone- 
ous. If he had been more of a philosopher, he would 
not have fabricated a theory founded wholly on hy* 
pothesis. Facts alone should constitute the founda- 
tion of every important theory in medicine. But 
he assumes the position that the vital principle is de- 
stroyed by deleterious particles, without ever evin- 
cing in any manner whatever that such particles do 
actually exist in the blood, or how they produce 
this effect. Is the vital principle decomposed by any 
chemical affinity, or do these particles by any pow- 
er of locomotion, insinuate themselves between the 
blood and the oxygene in the lungs and thus prevent 
the absorption of that principle ? Does he not know 
that all these symptoms may occur from an incapaci- 
ty in the lungs to make full inspirations, w ithout any 
reference to a deleterious principle ? If he does not, 
let him apply a ligature to the trachea, and he will 
soon be convinced that his laboured theory is the 
result of a plodding" imagination. 

" I now had to receive my most important lesson 
in this complaint, though at the expense of my pa- 
tients' lives." 

Comment on this paragraph is totally unnecessary : 

Our author's mind which has rung to all the 
clmnges in the treatment and theory of the epidemic, 

C 



18 



is now destined to experience another very impor- 
tant revolution. A recapitulation and condensed 
view of all these vicissitudes may not be unimport- 
ant. 

1st. He commences with bleeding, sweating, evac- 
uations and stimulants. 

2d. He omits bleeding and uses evacuants and 
stimulants. 

3d. He abandons stimulants and adopts emetics 
and cathartics alone, and reprobates the use of stimu- 
lants and tonics even in the convalescent stage. In 
the last opinion his mind appears to continue station- 
ary to the end of his first edition ; but no sooner 
does his second edition appear, than his pregnant 
mind is delivered of a totally novel and wonderful 
discovery. It is no less than a unity of remedy'' 
for all diseases. Astonishing fsecundity of imagina- 
tion! fortunati nos! we have lived to witness that 
happy era, when the jargon of the schools'' is abol- 
ished — when we shall be no longer perplexed with a 
four years study to qualify us for the practice of 
medicine ; we have only to learn Doctor Yates' 
imity of remedy," and we shall be perfectly com- 
petent to protract life to mature old age — to meet 
disease in its mildest or most malignant form. 

But as if to tantalize the medical world with dis- 
appointed hopes, or perhaps aware that it could not 
sustain the shock of such a sudden and total revolu- 
tion in science, the Dr. has neglected to disclose tliis 
omnipotent remedy. As the whole of his materia 
medica is now reduced to emetics and cathartics, we 
ma yreasonably infer that one of these will ultimately 
be designated as his. catholicon. The good women 



19 



will again be restored to their former station in 
science, and grateful for his exertions in their behalf, 
they will bestow on the Doctor the hi;^hest tribute 
of applause. 

But as we proceed in this wonderful pamphlet wc 
find even in his proximate cause something to excite 
cur curiosity. 

" The proximate cause appears to be a secretion 
of morbid acrid matter, or vitiated bile." 

To ascertain the verity of this hypothesis, we must 
have recourse to dissection; the following one se- 
lected from the New-England Journal, and perform* 
ed in Boston, will afford satisfactory evidence that 
bile is not the cause of the disease. It was a well 
marked case of the epidemic : 

" The body was examined the day after death — - 
the brain w-as very firm — its superficial veins were 
shrunk, but exhibited satisfactory marks of having 
been very much distended. The Tunica Arachnoi- 
des had many spots of coagulated lymph, by which 
the hemispheres were more closely connected than 
common — some water was found in the sentricles— 
the heart was in a sound state— the left hinff much 
discoloured, and partially hardened — the right lung 
was discovered lying in the upper part of its cavity 
covered by yellow coagulated lymph, its substance 
remaining entire. The lower part of the same cav- 
ity was occupied by a kind of cyst formed by a re- 
cent concretion of lymph, about a quarter of an 
inch ithick, on all sides, soft and readily torn and 
enclosing in its cavity, more than three quarts of 
thick and discoloured serum. The anterior surface 



20 



of the abdominal organs, the 'liver, spleen, stomacli, 
and intestines were covered with a most extraordina- 
rily thick coat of very yellow lymph, which cement- 
ed all these parts into one mass, and united them to 
the anterior parietes of the abdomen. This lymph 
Avas in many places an inch thick, and might be sep- 
arated into large masses. The whole peritoneal sur- 
face of the organs, and of the parietes of the abdo- 
men was in a greater or less degree covered with 
lymph. By the union of the different organs, the 
appearance of these parts was rendered as confused 
as is possible to conceive. In various places the ad- 
hering parts formed cysts of different sizes, which 
were usually filled with serum, containing a portion 
of semi-purulent lymph. The peritoneum and pleu- 
ra were generally very tender, and in some parts 
had the aspect of approaching gangrene." 

Had the Doctor's proximate cause the least foun- 
dation in truth, some of this vast quantity of bile, 
would certainly have been detected ia a case so care- 
fully and judiciously dissected. But instead of this 
we find a very thick coat of yellow lymph or 
slime covering every viscus and membrane of the 
abdominal and thoracick cavities, — ^^which the Doc- 
denies ever to have discovered in a single case. 

However he may have availed himself of extrane- 
ous aid to complete his compilations, I had uo ex- 
pectation that he would have gone back more than 
three hundred years and borrowed from the ancients 
their proximate cause of intermittents, and transferred 
it to the epidemic of this season. Being more familiar 
with ancient than modern opinions, perhaps he is still 



21 



ignorant that his proximate cause has been repeatedly 
disproved by subsequent improvements in medical 
science, and consequently long since exploded from 
the annals of medicine. He v^^ill therefore permit me 
to refer him to Wilson on Febrile Diseases, 91st 
page, where he will find the following quotation, 

^' It is one of the many opinions which have gen- 
erally prevailed respecting the proximate cause of 
intermittents, that they arise from an increased se- 
cretion or vitiated state of the bile. The particular 
state and frequent redundancy of the bile in inter- 
mittents, and still more in the remittents of warm 
climates, gave rise to this hypothesis/' 

The Doctor's reading has perhaps never extended 
to the objections which subsequent writers adduced 
against this theory, or he never would have adopted 
that for his proximate cause which is evidently no- 
thing but an effect of the disease. In proof of this 
opinion I will cite a few^ of the many conclusive au- 
thorities. 

Sir John Pringle says, " But after all the bile 
seems to be more the effect than the cause of inter- 
mittent fever. For whenever these fevers come to 
fan intermissions, they give way to the bark, a med- 
icine which as far as we know has no direct influence 
upon this humour. A ll therefore that can be said in 
favour of the ancient doctrine is that although the 
bile is not the first cause, yet from its redundance 
and depravation, owing perhaps to the fever, it fre- 
quently becomes a secondary cause of irritation/' 



23. 



Seneca observes, " If the bile be the cause of inter- 
niittents it must have acquired some particular pro- 
perties, for it is often discharged both upwards and 
downwards without inducing any fever of this kind: 
Kor are those who labour under jaundice more sub- 
ject to agues than others, and in these circumstances 
if ever, the bile should induce fever since the whole 
fluids; of the body are mixed with it," 

Wilson adds, " It would be supei^uous to attempt 
any addition to what these and others have suid res- 
pectirig this hypothesis, which unfounded as it is, is 
very ^^enerally blended with the writings of medical 
authors'' 

But the reasoning and experiments of Dr. Saun- 
ders ar e perfectly conclusive upon this point. Af- 
ter all his critical analysis of the nature and quali- 
ties of l:he bile he very decisively concludes that the 
increased secretion or vitiated quality of bile, is 
product ive of no disease but what may be easily 
remedied. The following are his own words. "1 
do not fciowever mean to deny that many and great 
inconveniences are found to arise from the preva- 
lence of bile in the primae viae, but I am firmly per- 
suaded that a diminution of its natural quantity 
would produce diseases of a more permanent and 
alarming nature. It is more difficult to supply the 
defect in the quantity of this fluid than to carry off 
its excess. It is even more easy to diminish its acri- 
mony than to increase its power'' 

If then the bile in its most vitiated state, cannot 
produce a single paroxysm of an intermittent, sure- 



23 



iy none but our erudite author could ever metamor- 
phose it into the proximate cause of a continued ma- 
lignant fever. Doctor Christopher C, Yates is here 
completely at issue with Dr, Saunders, and he has 
no alternative left to support his reputation, but to 
controvert this authority; a task, which with all his 
borrowed aid and pro/bwwc? erudition, he is totally in- 
competent to perform. He may have recourse to 
his ancient authorities for opinions which have long 
since been exploded. By these authorities he may 
prove the existence of morbific matter, the whole 
system of the humoral pathology, and even disprove 
the circulation of the blood. But the Dr. must ex- 
cuse me if I do not concur with him in the veritv of 
these opinions. I am one of those who believe that 
the moderns have essentially improved Medical Sci- 
ence, and that the work of Saunders upon the Liver^ 
is infinitely superior to all the visionary obsolete 
theories of the ancients upon this subject. 

But however the Dr. may be enveloped among 
the musty records of antiquity in search of author- 
ities to prove his theory, I defy him to corroborate 
it by any modern work of greater celebrity than his 
own pamphlet. 

I have hitherto admitted a principle which he pri- 
marily assumed without the least color of evidence, 
that the bile is in a vitiated state, and have proved 
conclusively from the most established authorities, 
that bile even in this state never can produce an inter- 
mittent or continued fever. 

It then necessarily follows that if bile in its vitia- 
ted state, never can be the cause of fever, in its mild 



24 



and natural state, it is perfectly innoxious. That 
this is the state of the bile till after the actual incep- 
tion of the Epidemic, I do positively assert ; and I 
defy Doct. Christopher C. Yates with all his ability 
to distort facts, to adduce a particle of proof to the 
contrary. 

How ridiculous then does the Dr. apppar with 
his proximate cause, on w hich his whole superstruc- 
ture and hopes of future fame were substantially 
founded. 

But ludicrous as it is, the opinion advanced in the 
public papers, by Doct. Alexander Coventry, of 
Utica, to relieve Dr. Yates from the embarrassment 
to which his proximate cause was subjected, has left 
the latter far in the back-ground. 

Dr. Coventry was aware that the increased secre- 
tion of vitiated bile, is peculiar to warm climates, 
and the consequence of long continued heat upon 
the hepatic system. He therefore reminds our au- 
thor of this circumstance, and of some modern ex- 
periments and discoveries of which he considers him 
as totally ignorant, and advises him to go back to the 
summer or autumnal months of last season, for the 
origin of his proximate cause, the generation of bile 
and its accumulation in the primse viee, where it has 
remained dormant and perfectly innoxious till it sud- 
denly explodes in the production of the epidemic. 
Elated with this visionary suggestion, our author 
abandons his former remote cause, which he had pla- 
ced in the atmosphere, and embraces this in his se- 
cond edition with extreme avidity. Having adopt- 
ed principles without being duly informed of their 



25 



accuracy, his mind is continually experiencing the 
greatest vicissitudes ; he precipitately adopts and 
as hastily rejects his theories. 

But the Doctor has probably seen cases of the 
epidemic during the spring, in which the patients 
enjoyed perfect health during the fall and winter 
preceding, till they were suddenly attacked in the 
spring. Will he be kind enough to reconcile this 
vast accumulation of bile for the long period of nine 
months, with the fruition of uninterrupted health? 
surely this humour cannot be so noxious as he would 
wish us to believe. But it is incumbent on him pre- 
viously to prove the actual existence of this vast 
quantity of bile. 

This subject is too absurd and ridiculous to re- 
quire any further refutation : I shall therefore sub» 
niit this difficulty to the solution of those adjunct 
theorists. Their mutual aid will, perhaps, relieve 
their mutual embarrassments, and procure a mutual 
dedication to their respective pamphlets. 

However these gentlemen may eulogise the splen« 
did talents and productions of each other in grati- 
tude for an epistle dedicatory^ I never shall expect 
any logical reasoning from either. Buffoonery is 
their fort, to which they may never expect men of 
science to descend. If Dr. Yates had placed his 
proximate cause in the liver or in the glands in gen- 
eral, he might have rendered his theory more consis- 
tent: But when he places it exclusively in the bile, 
he has evidently committed a gross error, and the 
whole system of cure which he has founded upon 
tLis hypothesis^ is consequently erroneous and ab- 

D 



26 



surd. What if the Dr. perseveres in emelics and 
cathartics till every particle of his proximate cause 
is evacuated, will the disorder then cease? No, the 
morbid irritation of the liver still continues and the 
bile is secreted with more rapidity than before. 
Upon the principle which he adopts, the disorder 
never can terminate, for his evacuants become con- 
tinued exciting causes of the secretion of bile, and 
w^ith the accumulation of this his proximate cause, 
the disorder must in the same ratio acquire strength. 

Without reflecting upon this effect of emetics on 
the hepatic system, he has founded his whole system 
of cure upon the discovery of bile thrown out by 
evacuants. 

To prove that this bile was not in the stomach be» 
fore, but that it was emulged from the biliary ducts 
by the remedies he employs, and that his hypothesis 
of the whole system of cure is consequently errone- 
ous, I shall cite a few competent authorities. 

Dr. Cullen says, " frequent vomiting emulges the 
biliary ducts and throws out much bile." 

Dr. Saunders — " The secretion of bile is frequent- 
ly increased and hurried by causes acting on the 
stomach, such as sea-sickness and emetics^ the dis- 
charge of bile by vomiting is tlierefore no proof of 
its having existed in the stomach before the exhibi- 
tion of the vomit, or of its having been the primary 
cause of nausea and indigestion, it is onl}/ the effect of 
direct action on that organ. In the bilious fever of 
the West Indies, the nausea and vomiting which 
arise from some slight degree of inflamnjation near 
the pylorus and upper surface of the duodenum, in- 



31 



ced by these different means without any copious' 
evacuation. His proximate cau-e in these cases 
must be completely confined in tlie primce vm, and 
in the utmost hazard of being totally suffocated. Can 
that vitiated bile which is capable of producing such 
sudden and powerful effects upon the system, as to 
endanger life in a few hours, be so perfectly changed 
in its quality as to become entirely harmless ? Will 
it in one hour prostrate the strength and energy of 
the body, and in the next conduce to a restoration of 
that energy? 

Dreadful alternative for the Doctor's proximate 
cause, I have a presentiment that between Scilla 
and Charybdis, it will ultimately sink into the whirl- 
pool of oblivion. 

To extricate himself from this wonderful dilem- 
ma he will undoubtedly consult his co-adjutors in 
science, and their combined decision will result in 
a total denial of the facts. Should he have recourse 
to this his usual expedient of refuting unanswerable 
arguments, his reputation will never sustain the shock 
of that iiTCsistable torrent of authorities, w hich rush 
in from every quarter. 

The more clearly to elucidate the doctor's charac- 
ter as a consistent writer, it may not be improper to 
designate a few passages for the reader to compare. 
These few I trust will stia]u]ate him to a more dili- 
gent enquiry, and I beg leave to assure hirn that if 
he examines the whole publication, with critical ac- 
curacy, he will scarcely find a page exempt from the 
most ridiculous inconsistencies. 

The doctor says in the 23d page of his 1st edition, 



32 



^^The discharge from the stomach is mixed with or 
followed by a slimy, whitish, compact substance,*^ 
and in the 46th page, that "in not one solitary in- 
stance have I observed gdatemus slime or any thing 
that resembled iV If he intends any difference be- 
tween "the slimy compact substance" and "gelati- 
nous slime/' it must be that the former is, as its name 
imports, a perfect slimy solid, and as I have never 
seen any solid substances ejected from the stomach, 
I must differ with him in this particular. But I have 
more charity for the doctor than to believe he in- 
tended to say,that his emetics ejected any perfect sol- 
id substances. I have, on the contrary, the strongest 
assurance to believe, that, in his description of symp- 
toms he candidly admitted the existence of a " sliaiy 
substance,'' because he had frequently seen it dis- 
charged from the stomach, and tliat lie would not 
have denied this "gelatenous slime" in the other 
place, had it not been enumerated by another prac- 
titioner, in his description of symptoms, whom he 
wished to contradict. 

His intemperate zeal to be in the opposition, has 
therefore in this instance induced him to contradict 
himself. 

" The morbid bilious secretions continue pouring 
into the gall bladder, giving rise by distending that 
viscous to the puin in the right side." 

If the distention of the gall bladder is the sole 
cause of the pain in the right side, I wish to know 
what produces it in the left side and in other parts 
of the thorax. Will the Doctor give his gall blad- 



33 



der ubiquity, or does he believe there are as many 
gall bladders as pains. 

" I hardly recollect a case in which a cathartic did 
not operate on its first exhibition. I have in no dis- 
ease found the bowels more susceptible of being 
moved by a single dose." 

I believe the Doctor stands entirely alone in this 
opinion. Every practitioner with whom I have con- 
ferred upon this subject, uniformly concur with me, 
that in no disease have they found such an obstinate 
constipation of the bowels. In some cases it was 
even impossible to procure evacuations, and I have 
heard a very respectable and venerable physician of 
this city declare, that he had been in consultation 
with Dr. Yates in one case where the Doctor had 
administered two drachms of tartrite of antimony 
without producing the least operation. Still the 
Doctor persists "that he has never found the bowels 
more susceptible of being moved by a single dose.'* 
I trust it is unnecessary to add more on a subject so 
perfectly clear and well known to every practition- 
er, to every patient, and almost to every person who 
has witnessed the Epidemic. That he should hazard 
such an assertion against such ''a mass of testimony, 
is therefore truly mysterious, and totally inexplica- 
ble. I however, would by no means impeach the 
Doctor's motives. They were no doubt perfectly 
honest and conscientious. His zeal to become useful 
to his fellow citizens has been prematurely disclosed 

E 



34 



in the adoption of errors, which reflection and his 
Tvell known candour will prompt him to retract. I 
cannot, however, sufficiently express my admiration 
of that elevation of sentiment which the Doctor 
evinces in his fortunate selection of tropes and figures. 
When he compares the Peripneumonia Typhoides to 
a White Black Sheep'' he exhibits an unerring test 
of a mind dignified with exalted ideas, and which 
soars at least as high as this elevated Figure. 

In the 49th page, in a note, the Doctor says, " he has 
condemned both stimulants and bleeding," and then 
inquires ironically," what is to be done when the pro- 
minent symptoms are so nearly balanced that pru- 
dence would dictate the use of neither of these clas- 
ses of remedies ? The patient is here left suspended 
between pneumonia and typhus, without any advice 
for his relief, his situation is truly singular/' 

Although the Doctor intended this note as one of 
his severest sarcasms for another practitioner, his 
want of penetration has prevented his discovering 
the applicability of it to himself. It will be per- 
ceived that in the first of the note he condemns both 
bleeding and stimulants, by his own confession then 
the residue applies to himself with peculiar force and 
propriety. 

^ This note is not dissimular to Hudibrass' gun, 

''•' Which recoils and kicks the o^^VDcr over/* 



35 



It seems the Doctor is doomed to embarrassments 
of this nature. 

" This invariable ejection of viscous slime re- 
sembling in tenacity and colour the white of an egg, 
has as invariably escaped my observation and that 
of other Physicians in this city as emetics have been 
administered." 

The Dr. has here made a positive assertion that 
neither he nor other Physicians in Albany ever dis- 
covered any slime that resembled the white of an 
egg. Unfortunately for his veracity, however, all 
the Physicians in this city who have given publicity 
to their opinions totally disagree with the Doctor in 
this respect. In confirmation of this fact I beg leave 
to select from the Medical and Philosophical Regis- 
ter, a quotation from the communications of Doctors 
Low and Eights. 

Dr. Low says " the bowels are generally costive 
and the stomach oppressed with a thick, glairy, te- 
nacious matter, resembling the aZ6w/7ie?i oi'/." 

Dr. Eights says "I confess I have not discovered 
those strong bilious symptoms as described by some 
Physicians. Many of my Patients to whom emet- 
ics have been administered evacuated little or no 
bile, but on the contrary a tough, glairy matter, in 



36 



some respects resembling the albuminous part of the 

To these gentlemen as residents of Albany, Doc- 
tor Yates makes a solemn appeal for the truth of 
what he states. Whether his veracity will deriT^e 
much support from theii' testimony the public must 
decide. 

I beg leave to refer the reader to those communi- 
cations, where he will find the symptoms described 
by these Physicians materially variant from those 
enumerated by Dr. Yates, 

Jaundiced indeed must be those opticks which in- 
stead of this vast accumulation of viscous slime, or 
glairy matter, can discover nothing but vitiated bile* 

When I commenced with his notes it was my in- 
tention to have bestowed upon each in succession a 
few critical remarks ; but the more I examine them 
the more I am disgusted with the attempt. 

They are so perfectly destitute of consistency, of 
importance, and of common decorum, that I must 
beg the reader to excuse me from accompanying 
him through this series of unprovoked invective. 

I trust, however, that he will not deem this char- 
acter of the work so perfectly satisfactory, as to pre- 
vent a critical investigation of its trutho 



37 



In his attempts to depreciate Dr. Mann's commu- 
nication he has treated the proceedings of the gen^ 
eral administration with indecent asperity. He very 
unwarrantably introduces their policy into a medical 
publication, for the purpose of bestowing upon it, 
a liberal portion of his censure. Such a course is 
unworthy a scientific performance. 

But to return to the 27th page, I have said that 
ttie syniptoms of this disease partook of the bilious 
gaol and malignant fever, but more particularly of 
thelatter.'^ 

Does the Doctor find in this epidemic, the brown 
or black tongue, the dark and fsetid sordes about the 
teeth, the livid flush of the countenance, and the 
acrid and more intense heat of the skin, that always 
characterize a malignant fever ? If he does, he has 
been very deficient in not enumerating them among 
his symptoms of the disease. 

But he ought to be informed that a malignant fe- 
ver is nothing more or less than a typhus gravior. 
The conclusion that necessarily results then is, that 
he considers the epidemic as a typhus gravior, from 
its commencement. In this opinion he will find but 
very few to concur ; neither do I believe that he 
intended to adopt it himself; but it is the neces- 
sary consequence of his premises. This is an- 
other dilemna which his sagacity never led him to 
suspect. 



38 



He has a peculiar typhus phohiay for altbeugh 
he labours with so much industry to prove this 
to be a malignant fever, he derides the idea 
of its having any connection with a typhus, or 
a typhoid slate of the system. His zeal has 
again surpassed his prudence, and exposed him to 
a variety of obvious inconsistencies and absurdi- 
ties. 

To go into a minute exposure of all these, more 
time is requisite than I have leisure or inclination to 
bestow. My only object, at present, is to excite the 
public to a more critical examination of the work- 
If the errors are discovered the injuries may be 
averted. 

I must therefore earnestly entreat the reader crit- 
ically to examine the authorities which he has addu- 
ced in support of his opinions. And I have no hes- 
itation to assure him, that he will find some of them 
mutilated and misquoted, so as to convey a mean-^ 
ing in some respects different from what the authors 
intended. 

That they shotild have escaped notice and ob- 
tained currency among the profession, is a sub- 
ject of surprise, and another evidence of the 
facility with which any opinion may be propaga- 
ted. 



39 



" Since the publication of this essay in February, 
I have been informed that one of these gentlemen 
has complained of the illiberality and unfairness of 
luy notes. This complaint might have had some 
colour of reason to support it, had I only given ex- 
tracts from, or garbled their publications. I gave 
them entire. That the public might judge of the 
fairness or liberality of my notes." 

I shall refer to only one instance to test the truth 
of this solemn appeal to the public. In the second 
communication, in the first sentence of the descrip- 
tion of symptoms, it will be perceived that he has 
changed " unequally" as it was originally, into 
" equally" which conveys an idea totally the re- 
verse of what was intended by the author. It will 
also be seen that he has framed a note for the pur- 
pose of ridiculing the sentiment which he has fabri- 
cated for this paragraph. — He has erected a shadow 
to accommodate the weapons with which he had to 
contend. He found nothing in the original commu- 
nications on which he could exercise that jioignanc}/ 
of wit and satire for which he is peculiarly distin- 
guished, and has therefore permitted his " plodding 
imagination" to conceive the bold idea of insertina^ 
them " entire" in his pamphlet for the purpose of 
altering the words, so as to convey a meaning which 
he could refute with the most success. 

For this and numerous other evidences of his 
prowess in science, the Doctor richly merits some 
noble distinction. 



40 



In his second edition the Doctor complains with 

much asperity, that any practitioner should differ in 

opinion with him and still use emetics and cathar- 
tics. 

I never before suspected that he claimed an exclu- 
sive right to the use of emetics and cathartics, 
or that he even pretended to be the author of this 
mode of treatment. Such however now appears to 
be his object, and his ire is most dreadfully excited 
because this practice is pursued without conferring 
on him the credit of the discovery. 

I have previously informed Doctor Yates that 
ever since the commencement of the epidemic I ne- 
ver entertained but one opinion of its nature and 
cure. The treatment which I then adopted I have 
since invariably pursued, except in one instance 
where I was obliged to deviate to accommodate a 
consulting physician — and if I were disposed like 
him to boast, 1 could say, that although materially 
different from his, it has been crowned with equal if 
not superior success. 

This treatment consisted internally of emetics, 
cathartics, diaphoretics, calomel, alkalies and opiates, 
and externally of the warm bath, spiritous fomenta- 
tions and epispastics, varying these remedies ac- 
cording to the diversity of symptoms which occurred. 
Although emetics and cathartics were of infinite util- 
ity in the cure, I have not like Dr. Yates confined 



41 



my treatment exclusively to these, nor even like him 
prescribed both of these, where contrary indications 
rendered them improper. 

Neither do J concur with him in explaining their 
useful effects. This I conceive to be an important 
point of difference, and one that will essentially con- 
troul the cure. 

He considers them useful only in proportion to 
the quantity of bile which they evacuate : such also 
is the reasoning of every superficial observer, who is 
ignorant of the oeconomy of the human frame. 

If the emetic discharges much bile they consider 
it as having completely attained the object for which 
it was prescribed, and I have heard some practition- 
ers express their astonishment, that, although their 
emetic had discharged no bile and very little of any 
thing, still their patient was essentially benefitted by 
the operation. A similar remark, I presume must 
have been made by every practitioner in medicine. 

This is an evidence that emetics have a much 
more extensive operation than merely to evacuate 
the stomach. And those who are influenced solely 
by superficial and visible effects, must also be con- 
vinced of the truth of this fact, by the universal 
sweat which they generally produce* 

But we have the most satisfactory evidence from 
authority and observation, that the effects of emetics 
and cathartics pervade the whole system and are pe- 
culiarly operative upon the glands and lymphatics. 
The healthy action of the liver is often restored by ; 
a single dose. 

Let those effects be once produced ; the healthy 

F 



42 



action of the glands be once restored, and that fluid 
which Dr, Yates is continually recruiting his forces 
to combat, will vanish like a charm. You will hear 
no more of his proximate cause, the absorption of 
•vitiated bile, or its accumulation in the alimentary 
canal. 

In prescribing emetics and cathartics therefore, I 
have this object in view, equally with the evacua- 
tions which they produce ; and on this principle we 
may satisfactorily explain the successful operation of 
the various and apparently opposite modes of treat- 
ment that have been pursued. 

In different ways they ultimately produce the same 
effects, they remove the morbid irritation of the 
glands and the torpor of the stomach and intestines. 

Stimulants succeed, by producing a genei al and more 
equal excitement through the system. Diaphoretics 
and calomel have a limited operation upon the 
glands and. lymphatics, and emetics and cathartics 
have an immediate effect upon the alimentary canal 
and an indirect one upon the whole system. 

From all these considerations, therefore, it evident- 
ly appears that the disease is general, affecting in de- 
gree all the secretions in the body; and that the mor- 
bid state of the liver is more obviously perceived 
than any other gland, originates solely from the mag- 
nitude of this organ, and the various and important 
uses to which its secretions are appropriated. 

Superficial physicians are therefore induced to 
overlook every other morbid affection, and to regard 
the livex and its secretions as the only object of 
rare. 



43 



And I have no doubt that the difference ^in opin- 
ion upon this subject amons; physicians orio;inates 
from that remissness to a dilioent investigation of the 
symptoms which peculiarly distinguishes some of the 
profession: If they discover any indications of a re- 
dundancy of bile, they are perfectly satisfied of the 
nature of the complaint, and their enquiries are ab- 
ruptly terminated in an immediate prescription of 
emetics and cathartics, to evacuate this fluid. 

In most cases the action which evacuants produce 
upon the alimentary canal, and their consequent in- 
direct effect upon the whole system, are sufficient to 
procure a healthy secretion in all the glands. But 
where these prove incompetent, the aid of other 
means is evidently requisite. In this respect also I 
essentially differ with Dr. Yates. 

Having experienced the utility of emetics and ca- 
thartics in only two instances, he seems elated with 
the discovery and hastily concludes to adopt them 
in every case to the exclusion of all other remedies. 

He therefore rigidly proscribes all other means of 
cure and says that " Doctor Wendell and Doctor Day^ 
two of the most respectable physicians in Albany^' per- 
fectly concur with him in opinion. 

If the partial, limited and incorrect view which 
Dr. Yates has taken of the epidemic, has influenced 
other practitioners to adopt the same error, it is cer- 
tainly a subject of extreme regret. I had hoped that 
this number would have been small and limited en- 
tirely to those physicians who had not an opportuni- 
ty of being very familiar with this disease^ 



44 



But if it is approbated by these two practitioners, 
and yielding to Dr. Yates his claims to respectabili- 
ty, we may thence fairly infer that the system which 
I oppose is advocated by at least three of ''the most 
respectable physicians in the city of Albany^' which af- 
fords the strongest evidence of the unequal terms on 
w hich I enter the field of controversy. Unequal as 
they are, I pledge my reputation, never to surrender 
the defence of truth. 

When the Doctor talks " of plucking out his heart 
and throwing it to the dogs" he uses a language to 
me totally mysterious, and as far as I can judge 
strongly indicative of a Typhomania. I trust howe- 
ver that his case is not entirely hopeless, but that by 
a judicious application of his " unity of remedy" he 
will be so far restored : ' i as to be able to 

communicate this grand Catholicon, this philoso- 
pher's stone in the third edition of his inimitable 
work, " for the benefit of the Albany Humane So- 
ciety." 



\ 



g 



- C. -^i-^" 



mm 



1^ 



